In light of what’s happening in our world, I figured this is a perfect time to do a post on diabetes and illness. This is not a post on COVID-19, but this post was inspired by COVID-19 and our nations’ current state. 

In general, there is a lack of understanding on the origins of diabetes, specifically type one (T1). While research is under-way regarding type one diabetes – its’ onset, a cure, prevention, genetic sequencing, stem cell use and the like – we do have a pretty good idea of what happens to the body in the onset of type one diabetes. It is widely believed that T1 is caused more so by environmental factors than genetic factors. The genetic link in type two diabetes is incredibly strong, however a physician did once tell me that T1 must have a genetic component, even if it stems back decades. It is believed that T1 is caused by a virus. This virus creeps into the body and essentially attacks the beta cells of the immune system. Beta cells are these teeny tiny cells within our pancreas that produce insulin; it is incredible that cells within this organ are responsible for something so impactful as hormone production (insulin is a hormone). To me, the pathophysiology is easy to understand, however the impact of the onset of a life-changing, life-taking, life-long disease is so incredibly burdensome and complicated.

As a result of beta cell degradation and eventual death (sometimes there are a few beta cells leftover still making insulin (not enough insulin to sustain life); this period is referred to as the “honeymoon period”), the individual now has a disease that has compromised the immune system and forever put them at a slightly higher risk than everyone else of getting sick and staying sick for longer. 

When you couple the attack on the immune system with hyperglycemia, you have a favorable platform for illness – viral and bacterial. We teach patients that germs love sugar. This concept might be hard to understand, so let’s break it down. Most of us learned in high school biology that the body must remain in homeostasis in order to function exactly as designed; this goes for every body process – blood pressure, acid-base balance, fluid volume, temperature, so on and so forth; blood sugar is no exception. Hyperglycemia (elevated blood sugar) creates a breeding ground for infection; I kind of think of it in terms of the blood not being as filtered and “clean” as it should be. In a state of hyperglycemia, we see decreased organ function. Think about what high blood sugar actually means – there is too much sugar in the blood, and blood flow is compromised. When blood flow is compromised to any organ (heart, brain, kidney, etc), we have decreased efficacy. This helps to explain why people with uncontrolled blood sugars are prone to strokes, kidney disease, neuropathy…

In general, when people with diabetes get sick, they get sick for longer. People with diabetes typically require extended use of medications used for treatment; for example, if I get a UTI, I am automatically prescribed a longer duration of antibiotics than your average, non-diabetic, individual. With any illness, tightly controlled blood glucose is KEY to recovery; I cannot emphasize this enough. We’ve all encountered the patient with the foot wound he’s had for two years; most often, these patients cannot heal because they cannot or chose not to control their glucose levels. You can throw antibiotics at a wound all day, but without proper glucose control, healing is merely a dream.

So, what does this all mean? It means that people with diabetes (both type one and type two) need to be careful! We have no evidence to support that diabetes is a risk factor for COVID-19 (the disease is way too new to know a lot about), but we do know that those with hypertension or other cardiac disease, obesity and advanced age are at an increased risk of contracting COVID-19. Guess what, though? Most people with diabetes have cardiovascular risk factors or diagnoses. Take from that what you will… I’ve read and listened to a few endocrinologists speak recently about the COVID-19 pandemic and what it means for persons’ with diabetes; they all echo each other in that blood glucose control is paramount. 

So, a few tips for sick-days – how to prevent them and what to do when they occur (by the way, I hope I don’t have to remind you all of this – I am not a doctor. I am an RN and CDE, and yes, I have advanced knowledge on the topic, but this is not me giving you or anyone medical advice that should replace the directive of your physician.)

• Have a written sick-day plan from your doctor. This means that you and your doctor have a conversation about what you should do when you become ill. The other items on this list will likely be included as part of your sick day plan. 
• Glucose control. I’ve harped on this enough. If you don’t get it by now, you won’t ever. 
• Ask your doctor how you are to adjust your medications when you’re ill. For me, I perform an automatic increase in my basal rate on my insulin pump, and I anticipate increased insulin usage until the illness has ceased. Don’t stop taking your insulin unless advised by your healthcare team. If you’re not on insulin, your provider may still have recommendations regarding the medications you are on when you become ill. 
• Check your blood sugar more often, and call your doctor when your numbers are too high. “Too high” is a different value for everyone, so talk to your doctor about when you should be concerned. 
• Stay hydrated. Hydration is important for obvious reasons, but water also helps to lower glucose in some situations. Water and sugar free fluids are recommended for hydration. 
• Be mindful of the medications you are taking to treat your illness. Most cough syrups and cold and flu serums are chock full of sugar. Opt for the sugar-free or no-sugar-added versions, when possible. Talk to your doctor about whether or not these over the counters are even necessary. Steroids increase blood sugars immensely, especially when given intravenously. Antibiotics can also mess with your blood sugar (and your birth control, FYI). 
• Don’t sit at home and hope you’ll get better if you have numerous risk factors and are getting worse. COVID-19 is a bit of a beast in this sense as the CDC wants you to stay home and seek care only when not improving at home. In all situations, a phone call to your doctor for advisement is warranted. Remember, you won’t heal as rapidly as others, and sometimes we can’t always kick a viral illness without a little support the way that other individuals can. 
• Check for ketones if your blood sugar creeps beyond 250mg/dL. This can be an early sign that you are in diabetic ketoacidosis. 
• Did I mention that tight glucose control is key to reducing your chances of getting sick in the first place?

That’s all for now, folks. 

Happy Social Distancing,

Kel